A life-threatening disease, such as cancer, confronts us with realities and questions that prompts to step back from our lives and reflect on the meaning and implications of the illness. Our perspective on these realities and questions emerges in large measure from our religious, spiritual or philosophical orientation, and it influences how we experience the illness--its meaning, how we feel about it and how well we come to terms with it. A religious perspective can help us as we grapple with these issues and seek to keep our bearing through the mental and emotional turmoil that comes with having cancer.

In order to discuss how religion and spirituality can help in dealing with cancer, we want to first review some of the religious and spiritual issues, questions and problems that cancer presents. These are questions of meaning--the meaning of our life and what is important, the meaning behind our personal affliction with cancer and finding meaning in our suffering.

The diagnosis of cancer confronts us with the fact that we are vulnerable to disease and suffering, that we are mortal and that our time is limited. When we are in good health, these realities often reside at the back of our minds; but when a serious illness strikes, they surge forward and challenge us. They challenge us especially with the question of whether we are using our time wisely. This question is linked to what our time is for--to what our life is all about. For many, these questions take on a central and compelling importance, which is why cancer is commonly referred to as a wake-up call.

Usually the most pressing priority when we are faced with the diagnosis of cancer is to regain our good health; if we succeed, the implications of our mortality might once again slip into the background. Sometimes the illness is regarded as only a temporary bump in the road of life, as opposed to a stark reminder of life's fragility. But more often than not, cancer has a way of capturing our attention, deepening our reflection on what is important and causing us to live with more awareness of ultimate priorities.

Patients who are fighting for their lives can be strengthened and sustained by a clear vision of what they want to survive for. Many talk of surviving for the sake of their families, to meet certain life goals and to fulfill certain inner potentials or strivings. Whatever a person's answer, it reflects deeply held religious, spiritual or philosophical beliefs about what is important and why.

As cancer patients reflect on their ultimate priorities, they often identify changes that they wish to make in themselves or their life. This is often referred to as the enlightenment of cancer or the gift of cancer. Countless patients have commented that they regret that it took a cancer diagnosis to wake them up and capture their attention, but they feel that many positive and overdue changes in themselves and their life have resulted from it. In making these changes, these patients have found some positive meaning in their illness.

Cancer confronts us with the question of why. As one person among many, we have been afflicted with this disease. Many patients have asked, in open protest or in private anguish, "Why did this have to happen to me?" Of course, the answer is that it did not have to happen, it just did. But there is often an emotional poignancy to this issue that cannot easily be dismissed.

One reason for this is religious: those who believe in the God of the Judeo-Christian Bible do not understand how such a God could allow cancer to happen to a good person. There must be some reason for it. It is not uncommon for patients to wonder whether the illness is a punishment for certain wrongs or failings of character. The Bible teaches that disease and death are the result of sin. Of course, many religiously oriented patients do not feel that they are being punished, but they do feel that their illness is somehow part of God's plan for them, and they struggle and pray to discern the higher purpose for which it is intended.

Even those who are not particularly religious can feel a sense of self-blame about their cancer because of the influence of the Judeo-Christian tradition in our culture. Many patients feel that if they can fix whatever is wrong in themselves, or adopt the right attitudes and behaviors, then the malignancy will be stopped. It has been argued, for example, that if patients heal themselves, or heal their lives, then physical healing will follow.

There are many dimensions to the suffering caused by cancer; physical, mental, emotional and spiritual. The suffering can involve all aspects of the person, including his or her relationships, roles, identity, hopes and plans, and the meaning of his or her life.

A person with cancer is challenged to respond to suffering in some way. Most patients, of course, strive to gain as much relief of their suffering as possible. Beyond that, some patients feel their only option is to endure it, either philosophically or stoically. Others seek to deny or downplay it, while some try to rise above it. Some regard it as an opportunity or challenge to demonstrate certain strengths of character or to bear witness to their faith.

Some patients rail against it as an outrage, and others are able to find some personal meaning in their suffering, especially in bringing about changes in themselves that they feel are important (such as acceptance or humility).

The religions of the world all contain, in one way or another, a philosophy or perspective on the meaning of suffering. Perhaps the perspective most widely known in our culture is the Judeo-Christian one, according to which suffering serves the positive purpose of deepening one's spirituality. Religious faith can bring a perspective to suffering that offers consolation or strength to those living through cancer.

When we talk about the meaning of an experience, we are talking about its relationship or connection to something larger or beyond the experience itself. For example, the meaning of a serious illness can be found in how it is related to the person's life as a whole. The meaning of one's life as a whole can be found in its connection to some larger reality, cause or purpose. Many people feel that their lives are meaningful because of the contribution they make to the lives of others.

To understand the roles of religion and spirituality in defining meaning for us, we must ask about the larger meaning of the lives of these other people. We might argue that the success of a human life contributes to the human adventure as a whole. We then might ask, however, whether the success of human evolution (physical, mental and moral) really matters, since humankind will not survive the eventual demise of our solar system.

Suppose there is some realm or cause within or beyond evolution. Fine. But, in order to have any meaning, what is it connected to? Thus, an infinite series of questions is launched here, wherein we can always ask about the larger reality to which something is meaningfully connected. Is there some ultimate reality that finally provides meaning to everything else?

These are the kinds of questions that lie at the heart of religion, faith and spirituality. These systems of belief all acknowledge a transcendent source of meaning and value beyond ourselves as human beings. At times of serious illness or crisis, it is to one of these systems that we may turn for solace, comfort and meaning; for the inner strength to endure the physical and emotional challenges of illness, and for guidance in our personal response to it.

Religion describes both the formal area of study of these belief systems and, more specifically, the organized understanding of beliefs shared by groups of people. The

Western religious tradition includes Judaism, Christianity and Islam. The Eastern religious tradition includes Buddhism, Taoism and Hinduism. Each religious system is based on a core of beliefs, often articulated through a set of ancient texts that are considered authoritative and sacred. These bodies of literature incorporate that religion's values and teachings, providing the source of answers to many profound human questions.

Faith often refers to the beliefs held by an individual who is an adherent of one of the formal systems of religion. Each of us, whether we know it or not, holds some kind of faith. We may believe in a personal God or in a Divine Clockmaker (that is, a God who created the world, set it in motion and then left it alone). This faith may be spelled out by a formal systematic theology or comprise pieces of many different religious teachings. This personal faith is frequently deep and forms a foundation of emotional and spiritual strength when we face crisis, cancer and, especially, death.

Spirituality is the connection that many people feel to God or to something beyond us, but not in accordance to the formal teachings of traditional religion. Thus, many people speak about being spiritual but not necessarily religious. While some people seek their answers in religious literature and traditional teachings, others search beyond traditional models to find answers that will bring them emotional and existential meaning.

A person's faith or spirituality provides a means for coping with illness and reaching a deeper kind of inner healing. Coping means different things to different people: it can involve finding answers to the questions that illness raises, it can mean seeking comfort for the fears and pain that illness bring and it can mean learning how to find a sense of direction at the time of illness. Religious teachings can help a person cope in all of these dimensions.

Religious teachings can also point the way toward healing, which can be something very different from curing. Modern medicine has been able to recognize that a medical cure is not always possible; nor is it the only appropriate goal for treatment. Sometimes, when treatment is futile, the healing of soul or spirit can provide a deep and sustaining comfort; religion has long focused upon this as its central purpose. Healing of the soul or spirit means recognizing the values in one's life and striving to bring these in line with the teachings of one's religion or the fundamentals of one's faith.

The meaning of life and death, humanity's purpose or direction and the struggle with suffering and pain have long been central themes in religious literature.

Within the context of many traditional belief systems, the ultimate answer to meaning, suffering and death resides with God alone. One conservative religious answer is that

God's ways are beyond human understanding, but we must trust in God's goodness and purpose. Many people feel a great sense of confidence and assurance in the belief that an all-powerful, all-knowing deity controls the world. The idea that the reward for a life well lived is eternal rest in heaven is usually associated with this conservative belief.

Liberal theologies offer other explanations about God's place in human experience. Some hold that God has created an imperfect world and that it is our task and responsibility as humans to work toward the world's repair or perfection. This means that we share an obligation to help one another face the struggles of human existence, including illness and death.

Some humanistic religious traditions assert that God has no direct influence on contemporary human events. They assert that when we suffer, all that God can do is to be present with us. The comfort in this belief system comes from the conviction that God feels our pain and knows what we are going through when we suffer.

For many patients, the why me? issues are essentially religious in nature. Religious people sometimes are concerned that illness relates to some sin that they have committed.

Most religions today reject the idea that God punishes us through illness. Many people hold to an alternative view--that illnesses, such as cancer, demonstrate the presence of evil in the world. Religion gives us the opportunity to help others and thereby overcome evil or imperfection by creating good.

Most theologians and religious leaders today acknowledge that there are no simple answers to these questions. They also recognize that the question Why me? is really not so much a question requiring an answer as a cry of emotional and spiritual pain. Rather than try to address this question with theological formulas that bring little consolation, they strive instead to honor the emotional anguish behind these questions and to point to the comfort, reassurance and broader perspective offered in religious teachings.

In the face of a serious illness, we are often challenged by a range of emotional reactions that can be unfamiliar and more intense than anything we have ever encountered. We feel ourselves vulnerable and in need of a stable and solid support. Religion steps in with comfort and reassurance.

One of the great sources of emotional support in times of illness is the Book of Psalms. For those of us familiar with the Western religious canon, no voice speaks more compassionately and with greater understanding of the emotional upheaval of crisis than the Psalmist. From the 23rd Psalm (King James Version), we read: "Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me; thy rod and thy staff they comfort me."

When we are confronted by cancer or other serious illness, our sensory experience is often heightened, both in regard to the beauty of life and its more fearful, ugly and painful side.

Our emotional connection to the world can become more intense. Religious tradition places this experience in an ancient perspective. We recall the stories of great sages and saints who also faced hardship and death. They instruct us about the intensity and how our path has been traveled before by so many others. Our feelings direct us to a new connection to the world and God's presence in it.

Another dilemma confronting us when we are faced with cancer relates to what we are to do. We wonder how to act, how to function at this time. It seems that the ordinary ways of living and functioning are inappropriate or trite. Religion again assists us with models of behavior to lift up the values we hold as important. Spiritual disciplines and teachings of various kinds can instruct us in structured exercises.

Asceticism is an example well known through religious history. Simpler examples of responses supported by religion include giving to charity and helping others. Religion teaches us that we can find order and direction by doing things that foster our spiritual well-being and energy. These can include some of the practices that follow.

Many conventional religious resources and practices help us cope with cancer by offering comfort, support and direction.

Rituals and prayer are the central and best-known religious techniques. Prayer extends comfort in many ways. It offers us consolation, encouragement, connection and solace.

We experience a sense of divine presence and divine love as we pray. Prayer and ritual touch deep feelings within us. They allow us to give voice to our pain, joy, grief, loss, isolation, alienation and loneliness. Prayer evokes memories of our youth and of our family and long-standing relationships. It also brings a sense of power and awesome mystery. Prayer reveals a side of ourselves that may be needy, that we may not want to reveal, that struggles with certainty and in which our inner child resides.

Prayer techniques such as centering, traditional prayer, meditation, guided meditation and anointing have long been recognized as effective tools in dealing with illness. Recent scientific studies reported in books such as Dr. Larry Dossey's Healing Words prove beyond doubt that prayer makes a difference.

Four nondenominational prayers for healing, selected by the pastoral care staff at the UCSF/Mount Zion Medical Center, are found at the end of this chapter.

The religious community is a powerful ally in dealing with crises in our lives. People who know us and care about us from within a community of faith are important partners in the healing process. Apart from the effectiveness of their love and prayers, the religious communicants can often provide practical support for the tasks of daily life that need to be done.

We should not underestimate the value of clergy visits for helping us to cope with cancer. In many ways, the presence of clergy powerfully conveys the message of God's care to those who are ill. Clergy tangibly represent God's caring presence, both through their being there and through the words they speak.

Healing practices associated with religion and focused upon cancer and other illnesses have become much more common today than ever before. Some of these practices come from fringe groups and charlatans seeking to prey upon frightened people. Yet mainstream religion has also recognized the value of healing prayer services and rituals as an adjunct to more typical prayers and rituals. Some rituals of this kind are ancient. Some are contemporary. Many people have sought and found healing and comfort through religious tradition and practice.

These four nondenominational prayers for healing have been selected by the pastoral care staff at the UCSF/Mount Zion Medical Center.

My God and God of all generations, in my great need I pour out my heart to you. Long days and weeks of suffering are hard to endure. In my struggle, I reach out for the help that only you can give. Let me feel that you are near, and that your care enfolds me. Rouse me with the strength to overcome my weakness, and brighten my spirit with the assurance of your love. Help me to sustain the hopes of my loved ones as they strive to strengthen and encourage me. May the healing power you have placed within me give me the strength to recover so I may fulfill my journey in the Divine Plan.

In sickness I turn to you, O God, as a child turns to a parent for comfort and help. Strengthen within me the wondrous power of healing that you have implanted in your children. Guide my doctors and nurses, that they may speed my recovery. Let the knowledge of your love comfort my loved ones, lighten their burdens and renew their faith. May my sickness not weaken my faith in you, nor diminish my love for other human beings. From my illness may I gain a truer appreciation of life's gifts, a deeper awareness of life's blessings, and a fuller sympathy for all who are in pain.

Send me, O God, your healing, so that I may quickly recover from the illness that has come upon me. Sustain my spirit, relieve my pain and restore me to perfect health, happiness and strength. Grant unto my body your healing power so I may continue to be able to bear testimony to your everlasting mercy and love, for you, O Lord, art a faithful and merciful healer.

Be at PeaceDo not fear the changes of life--Rather look to them with full hope as they arise.God, whose very own you are,Will deliver you from out of them.He has kept you hitherto,And He will lead you safely through all things;And when you cannot stand it,God will bury you in His arms.Do not be afraid of what may happen tomorrow;The same everlasting Father who cares for you todayWill take care of you then and every day.He will either shield you from suffering,Or He will give you unfailing strength to bear it.Be at Peace--And put aside all anxious thoughts and imaginations.
--St. Francis de Sales